Fraser Health, Doctors of BC and the White Rock/South Surrey Division of Family Practice joined forces to reduce unwise patient uses of the Peace Arch Hospital Emergency Department.
Emergency is for emergencies.
It seems obvious – hospital emergency departments are designed to deal with life-threatening illnesses and critical injuries.
But when Dr. Grace Park looked around a packed ER waiting room at Peace Arch Hospital, she could see that simple message wasn’t getting through.
Statistics showed half of all visits to Peace Arch Hospital’s Emergency Department were for non-emergency cases – everything from colds to small cuts – issues much better treated by a general practitioner.
“We needed to save emergency to address the really acute patients,” said Dr. Park, Regional Medical Director for Home Health.
So she discussed the issue at length with the White Rock-South Surrey Division of Family Practice and together, stakeholders from Fraser Health and the Division partnered to find a solution.
They co-created the Right Care Right Place Project Team to tackle the issue. The team included Dr. Park, a practicing family physician; Dr. Amir Behboudi, Peace Arch Hospital ER physician; Teresa O’Callaghan, Director of Clinical Operations; Jessie Saran, Manager of Clinical Operations at Peace Arch Hospital; Bonnie Irving, Senior Communications Consultant; Erin Corry, Leader, Practice Support Program; Nancy Mathias, White Rock-South Surrey Division of Family Practice Executive Director; Clare O’Callaghan, Doctors of BC Communications Manager; and Julie Harrison, Project Manager, Doctors of BC.
Foundational planning for the initiative was shaped by Nancy Mathias and Petra Pardy, who was then Executive Director for Primary Care and Aboriginal Health.
Some of the project’s early work was completed by Amrit Rai, Director of Clinical Operations for Primary Health Care; Martha Cloutier, then Director of Clinical Operations for the Emergency Department for Peace Arch Hospital; Wendy Newson, who was then Site Director for Peace Arch Hospital; Larisa Saunders, Director, Corporate Communications at Fraser Health; Kay Abelson, Program Coordinator with White Rock-South Surrey Division of Family Practice; and Jodi Kortje, then Manager, Clinical Operations of Emergency at Peace Arch and Delta Hospitals.
Fraser Health research showed up to 50 per cent of visits to Peace Arch Hospital’s ER were not for emergencies.
So the team secured grant funding from the Peace Arch Hospital and Community Health Foundation, and worked on connecting patients with local general practitioners and walk-in clinics.
After 10 months of research they launched the Use your ER Wisely campaign in December 2015. They worked with family physicians to institute same-day appointments to increase capacity for immediate care, and ran a public education campaign informing patients about same-day slots and 24/7 access to HealthLink BC’s 811 resource. They advertised that local pharmacists could help with prescription advice, and used Medimap software in the Peace Arch Hospital waiting room to tell patients where to find nearby walk-in clinics and what their wait-times were – often just 15 minutes. White Rock-South Surrey was the first community to partner with Medimap, which is now in more than 250 clinics across Canada.
When the team checked back in on the ER in 2016, they found congestion down between two to eight per cent each month.
“The results were actually even better than they appeared, because overall visits to the ER actually increased during that period and yet we still saw a reduction in non-emergency cases,” Dr. Park said. “Patients are seeing that they don’t have to sit there and wait. It’s making a real difference in connecting patients to the right care where they need it.”
Getting to that point involved extensive collaboration with HealthLink BC, the College of BC Pharmacists, Medimap developers, White Rock municipal leaders, local media, community centres and libraries. It was so successful other B.C. hospitals and Divisions expressed interest in duplicating it – Chilliwack, Hope, Delta and Surrey for example. The team created a toolkit so communities could launch their own version of the campaign.
“I think there’s been a culture change,” Dr. Park said. “The education is out there that the ER is not the only place where you can get some of these health issues looked after and physicians are speaking to their patients about it.”
Colleagues, too, recognized the enormous amount of coordination and drive it took for the team to make a real difference in conserving acute care resources.
Dr. Neil Barclay, Fraser Health Regional Medical Director of the Emergency Network, praised the team’s “complementary skill sets, connections, loyalty, enthusiasm, dedication for their work and appreciation for one another.”
“They had a strong sense of purpose,” added Rhonda Veldhoen, Interim Vice President of Community Hospitals and Programs, and former Executive Director of White Rock-South Surrey and Peace Arch Hospital, “and throughout the project, the team had a ‘we can make this work’ attitude.”
“The first step in any kind of change is to get the right people in the room,” Dr. Park said simply.
Just not in the ER waiting room.